Simple Low Cost Interventions Yielding Extraordinary Outcomes

1. Simple Low Cost Interventions Yielding Extraordinary Outcomes

2. IHI Mandatory Reporting CDC The World of Healthcare Is Changing How We Can Help? CMS MRSA/MDRO’s

3. The Industry Today • Centers for Disease Control (CDC) • Center for Medicare/Medicaid Services (CMS) • POA 10/1/08 • Mandatory Reporting • Institute for Healthcare Improvement (IHI) • Consumerism • Food and Drug Administration (FDA)

4. The Industry Today Center for Medicare/Medicaid Services (CMS) • Infection tracking begins Oct. 1, 2007 • Reporting begins Oct. 1, 2008 • Pressure Ulcers • Vascular and Urinary Tract Infections from catheters • Mediastinitis • Falls • “Never Events” • VAPs (2009) Source: Federal Register, Vol 72, No 162, August 22, 2007

5. The Challenges Hospital Acquired Infection (HAIs) costs cited in the literature (per event) Pressure Ulcers $30,0001 UTI’s $4,7002 SSI’s $25,5003 MRSA SSI’s $100,0004 VAP’s $40,0005 1. Amlung SR, et al, Adv Skin Wound Care, Nov/Dec 2001; 14(6):297-301. 2. Chen Yin-Yin, Chou Yi-Chang, Chou Pesus. Impact of nosocomial infection on the cost of illness and length of stay in intensive care units. Infection Control Hosp Epidemiology 2005; 26:281-7. 3. Stone PW, et al, Am J Infec Control. Nov 2005; 33(9): 501-9. 4. Engemann JJ, et al, Clin Infec Dis 1 March 2003; 36(5): 592-8. 5. Rello J, et al, Chest, Dec 2002; 122(6):2115-21.

6. The Sage Solution • Fundamental belief in prevention versus treatment • Simple, low cost interventions • Documented success as Best Practice • Focused effort

7. Interventional Patient Hygiene Bathing Risk factors for HAI’s and Early Detection of Skin Injury Incontinence Care, Heel Floatation Risk Factors for Pressure Ulcers Oral Care Risk factors for Hospital Acquired Pneumonia Preoperative Skin Preparation Risk of Surgical Site Infection

8. Issue: Pressure Ulcers — Heels The Sage Solution • Second most common pressure ulcer1 • Many products on market are ineffective • Proven outcomes in heel ulcer reduction2 1 Whittington KT, Briones R, Adv Skin Wound Care. Nov/Dec 2004; 17(9):490-4 2 Walsh JS, Plonczynski DJ, Journal of Wound, Ostomy & Continence Nursing. March/April 2007; 34(2):178-183

9. Issue: Pressure Ulcers — Heels The Sage Solution Cost of intervention: $100 per patient Garrett D, Intervention with a new heel protection device and silver alginate dressing to prevent amputation of lower leg due to stage IV ulcer of the heel and malleolus. Case study conducted at Salem Village Nursing and Rehabilitation Center, Joliet IL, Oct 2006

10. Issue: Skin Injury (Pressure Ulcers) The Sage Solution • All-in-one approach to Incontinence Associated Dermatitis (IAD) • Barrier solution inthe cloth • Proven reduction in IAD of up to 62% Driver S., Crit Care Nurse 2007 Aug: 27(4): 42-46

11. Issue: Skin Injury (Pressure Ulcers) The Sage Solution Cost per LOS for the patient with fecal incontinence: $12 Sluser S, Consistency the key for treating severe perineal dermatitis due to incontinence. Poster presented at the Clinical Symposium on Advances in Skin and Wound Care (ASWC), Las Vegas, NV, 2005 Oct.

12. Issue: Surgical Site Infections — MRSA The Sage Solution • Unique solution of 2% CHG lefton skin • Documented reduction of MDROs • Proven reduction in infections 1 Prospective evaluation of six pre-operative cutaneous antiseptic regimens for prevention of surgical site infection, Poster presented at SHEA Conference, March 2006, Maki DG, Paulson DS. 2. Pre-operative Skin Preparation Protocol Results in Reduced SSI Rates, Rhee H, MD, Chair Infection Control Committee and Harris B, CIC, Infection Control Practitioner, Presented at Institute for Healthcare Improvement (IHI) Orlando, FL, December 2007.

13. Issue: Surgical Site Infections — MRSA The Sage Solution Cost per patient per surgery: $5.50 per day

14. Issue: Ventilator Associated Pneumonia (VAP) The Sage Solution • Comprehensive approach to oral care • Market share leader1 • Five years of clinical success documenting dramatic reduction and even elimination of VAP2 1 Based on GHX market share data, 2007 Suction Oral Care and Non-Suction Oral Care categories 2 Studies and symposia presentations found at http://www.sageproducts.com/education/vsymposiaPres.asp and http://www.sageproducts.com/education/varticles.asp

15. Issue: Ventilator Associated Pneumonia (VAP) The Sage Solution Average cost per patient in ICU: $100

16. Revenue PreservationPotential investment per ICU patient Incontinence $12/stay Prevalon Boot $100/pair Comfort Bath $6/stay CHG $11/stay Oral Care $100/stay TOTAL $229/stay* * Assumes ICU average LOS 3.2 days. Additional $44.25./day after 3 days

17. Simple, low cost interventions 1. Amlung SR, et al, Adv Skin Wound Care, Nov/Dec 2001; 14(6):297-301. 2. Rello J, et al, Chest. 2002. Dec; 122 (6):2115-21. 3. Chen Yin-Yin et al, Infect Control and Epidem. March 2005; 26:281-7. 4.Engemann JJ, et al., Clin Infect Dis. 1 Mar 2003; 36(5): 592-3-8. * Assumes ICU average LOS 3.2 days.

18. Sage Commitment • Focus • Educate • Implement • Measure • Delivered Outcomes

19. Pressure Ulcer’s UTI’s The World of Healthcare Is Changing How Can We Help? VAP’s SSI’s MRSA

20. Thank You For Your Time